Provider Demographics
NPI:1538616180
Name:ADAM, STEPHANIE (OCCUPATIONAL THERAPY)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ADAM
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170-22 130TH AVENUE
Mailing Address - Street 2:APT 12C
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434
Mailing Address - Country:US
Mailing Address - Phone:347-666-4277
Mailing Address - Fax:
Practice Address - Street 1:170-22 130TH AVENUE
Practice Address - Street 2:APT 12C
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434
Practice Address - Country:US
Practice Address - Phone:347-666-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020547-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist